Abstract
A sternal foramen (SF), which arises from the incomplete fusion of the cartilaginous neonatal sternum, is a relatively common anatomical variation found in 2.5% to 13.8 % of all individuals. SFs are usually located at the lower third of the sternal body and their average diameter is 6.5 mm. An SF is subclinical; however, its close proximity to the thoracic organs, i.e., the heart and lungs, entails a risk of serious complications from blinded sternal interventions. Moreover, its presence can lead to misinterpretation of radiological and postmortem findings. The SF is ignored by many physicians and non-physician healthcare providers who must understand its clinical significance in order to optimize patient care. Our aim in this review is to highlight the potential clinical consequences for SF patients, discuss recommendations for performing sternal procedures safely when this anatomical variation is present, and preclude radiological and pathological misinterpretations so that patient care can be improved.
Highlights
BackgroundReceived 12/01/2017 Review began 12/05/2017 Review ended 12/05/2017 Published 12/08/2017The sternal foramen (SF) was first observed in 1649 and first described in 1707 (Figure 1) [1]
A sternal foramen (SF), which arises from the incomplete fusion of the cartilaginous neonatal sternum, is a relatively common anatomical variation found in 2.5% to 13.8 % of all individuals
The SF is ignored by many physicians and non-physician healthcare providers who must understand its clinical significance in order to optimize patient care
Summary
Received 12/01/2017 Review began 12/05/2017 Review ended 12/05/2017 Published 12/08/2017. Blinded sternal interventions in patients with an SF can lead to fatal injury in the pericardium (11%-20% of all SFs lie directly against the pericardium), right ventricle of the heart (an SF is adjacent to the right ventricle in 99.31 % of all cases according to Papadimitriou, et al.), the aorta, or the lung (about 50% of all SFs neighbor the lung) [4,5,6,7,8,9,10,11, 13, 17,18] This is especially true if the foramen is located in the inferior body of the sternum [3]. It is important to review the victim’s medical records to aid in an accurate investigation of the cause of death [7]
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